Table 3.

Candidate scenarios for PPI use-reduction

Clinical scenario where PPI use-reduction should be considereda
Symptoms of mild oesophagitis (LA A, B) or NERD, now controlled
Uninvestigated reflux-like symptoms, now controlled
After 4–12 weeks of empirically treated dyspepsia
After eradication therapy for H. pylori-associated gastric or duodenal ulcer (eradication should be confirmed with stool antigen test 1 month after cessation of PPI)
After eradication therapy for uncomplicated H. pylori infection
After hospital/ICU admission wherein PPI therapy was initiated for stress ulcer prophylaxis, anaesthesia, or empirically
Inappropriate prescription for gastroprotection in patients with comorbidities
PPI indication unclear

H. pylori, Helicobacter pylori; ICU, intensive care unit; LA, Los Angeles classification of gastro-oesophageal reflux disease; NERD, non-erosive reflux disease; PPI, proton pump inhibitor.

^aPatients with an approved indication for chronic PPI should not be considered for discontinuation.